Antidepressants

Antidepressants are used to alter the concentration of neurotransmitters in the brain that is responsible for the depressed affect (feelings in response to the environment, whether positive and pleasant or negative and unpleasant).

These drugs counteract the effects of neurotransmitter deficiencies in three ways:

Inhibit the effects of monoamine oxidase (MAO) resulting to increased norepinephrine and serotonin or 5-hydroxytryptamine (5-HT) in the synaptic cleft;

Block the reuptake function of the synaptic cleft resulting to increased neurotransmitter levels in the synaptic cleft; and

Regulate receptor sites and breakdown of neurotransmitters resulting in accumulation of neurotransmitter in the synaptic cleft.

Depression is an affective disorder characterized by a persistent and intense feeling of sadness much more severe and longer lasting than the suspected precipitating event. There may be no external causes.

Individuals with depression have little energy, disturbed sleep patterns, loss of appetite, and absence of motivation to perform activities of daily living. They describe overwhelming feelings of sadness, despair, hopelessness, and disorganization.

It can interfere with a person’s life, his family, job, and social relationships. It can lead to multiple physical problems that further depression and increase risk of suicide.

Researches about drugs that can effectively relieve depression lead to the formulation of biogenic amine theorywhich states that depression results from a deficiency of biogenic amines (NE, dopamine, and 5-HT) in key areas of the brain that regulate arousal, alertness, attention, moods, appetite, and sensory processing.

Tricyclic Antidepressants (TCAs)

Has three sub-class namely: amines, secondary amines, and tetracyclics

Assess for history of seizure disorders, psychiatric problems, suicidal thoughts and myelography within the past 24 hours or in the next 48 hours to avoid potentially serious adverse reactions.

Perform a thorough physical assessment to establish baseline data before drug therapy begins, to determine the effectiveness of therapy, and to evaluate for the occurrence of any adverse effects associated with drug therapy.

Monitor results of electrocardiogram and laboratory tests (e.g. renal and liver function tests) to monitor the effectiveness of the therapy and provide prompt treatment to developing complications.

Evaluate patient understanding on drug therapy by asking the patient to name the drug, its indication, and adverse effects to watch for.

Monitor patient compliance to drug therapy.

Monoamine Oxidase Inhibitors (MAOIs)

Monoamine oxidase (MAO) is an enzyme found in nerves and other tissues. MAOIs exert their effect in relieving depression by inhibiting this enzyme to break down the biogenic amines NE, dopamine, and 5-HT.

Now used rarely because of their strict and specific dietary regimen to prevent toxicity. However, there are patients who respond only to MAOIs and so these remain to be available.

Therapeutic Action

By blocking the breakdown of the biogenic amines, these drugs pave way for the accumulation of NE, dopamine, and 5-HT in the neuronal storage vesicles to cause increased stimulation of the postsynaptic receptors. This increased stimulation is thought to be the reason for the relief of depression.

Indications

MAOIs are generally indicated for patients who do not respond to other safer antidepressants.

Children

Avoided in children if at all possible because of the potential for drug-food interactions and serious adverse effects.

Adults

Adults must be educated that effects of drug therapy may not be seen for 4 weeks.

Also, the cause of depression must be ruled out before therapy begins.

Use cautiously for pregnant and lactating women because of potential adverse effects to fetus and baby.

Older adults

Older adults more susceptible to the adverse effects of the drugs and from CNS effects (e.g. increased sedation, dizziness, etc.)

Doses of these drugs need to be reduced and careful monitoring for drug toxicity is a must, especially for those who have hepatic and renal impairment.

Perform a thorough physical assessment to establish baseline data before drug therapy begins, to determine the effectiveness of therapy, and to evaluate for the occurrence of any adverse effects associated with drug therapy.

Monitor results of electrocardiogram and laboratory tests (e.g. renal and liver function tests) to monitor the effectiveness of the therapy and provide prompt treatment to developing complications.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

Perform a thorough physical assessment to establish baseline data before drug therapy begins, to determine the effectiveness of therapy, and to evaluate for occurrence of any adverse effects associated with drug therapy.

Nursing Diagnoses

Here are some of the nursing diagnoses that can be formulated in the use of this drug for therapy:

Evaluate patient understanding on drug therapy by asking patient to name the drug, its indication, and adverse effects to watch for.

Monitor patient compliance to drug therapy.

Practice Quiz: Antidepressants

Practice questions from our nursing test bank about antidepressants. Can you get a perfect score?

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Practice Quiz: Antidepressants

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Question 1

Nortriptyline and protriptyline are classified as what class of TCAs?

A

Amines

B

Secondary amines

C

Tetracyclics

D

None of the above

Question 1 Explanation:

Examples of amines include amoxapine, amitriptyline, clomipramine, doxepin, and clozapine. Example of tetracyclic include maprotiline.

Question 2

The following are true about depression, except:

A

External causes always play a part in assessment and diagnosis.

B

Patients with depression have trouble sleeping and eating.

C

Depression can lead to multiple physical problems.

D

None of the above.

Question 2 Explanation:

Depression can have no external causes.

Question 3

Which TCA is also approved for use in patients with OCD?

A

Imipramine

B

Clomipramine

C

Sertraline

D

Amitriptyline

Question 4

A combination of MAOIs and TCAs will precipitate which drug adverse effect?

A

Severe hypertensive crisis

B

Severe hyperpyretic crisis

C

Severe hypnotic crisis

D

Severe amnesia

Question 4 Explanation:

It is accompanied by convulsions, hypertensive episodes, and even death.

Question 5

What is the treatment for hypertensive crisis caused by MAOI?

A

Phentolamine

B

Adenosine

C

Propanolol

D

Nifedipine

Question 6

How many weeks will the full therapeutic effects of SSRIs be realized?

A

2 weeks

B

4 weeks

C

6 weeks

D

8 weeks

Question 6 Explanation:

Therefore, it is important for nurses to instruct patients that effects of the drug will not be instantly feel and experienced.

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Practice Quiz: Antidepressants

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Congratulations - you have completed Practice Quiz: Antidepressants. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

Your answers are highlighted below.

Question 1

Nortriptyline and protriptyline are classified as what class of TCAs?

A

Amines

B

Secondary amines

C

Tetracyclics

D

None of the above

Question 1 Explanation:

Examples of amines include amoxapine, amitriptyline, clomipramine, doxepin, and clozapine. Example of tetracyclic include maprotiline.

Question 2

The following are true about depression, except:

A

External causes always play a part in assessment and diagnosis.

B

Patients with depression have trouble sleeping and eating.

C

Depression can lead to multiple physical problems.

D

None of the above.

Question 2 Explanation:

Depression can have no external causes.

Question 3

Which TCA is also approved for use in patients with OCD?

A

Imipramine

B

Clomipramine

C

Sertraline

D

Amitriptyline

Question 4

A combination of MAOIs and TCAs will precipitate which drug adverse effect?

A

Severe hypertensive crisis

B

Severe hyperpyretic crisis

C

Severe hypnotic crisis

D

Severe amnesia

Question 4 Explanation:

It is accompanied by convulsions, hypertensive episodes, and even death.

Question 5

What is the treatment for hypertensive crisis caused by MAOI?

A

Phentolamine

B

Adenosine

C

Propanolol

D

Nifedipine

Question 6

How many weeks will the full therapeutic effects of SSRIs be realized?

A

2 weeks

B

4 weeks

C

6 weeks

D

8 weeks

Question 6 Explanation:

Therefore, it is important for nurses to instruct patients that effects of the drug will not be instantly feel and experienced.

Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results

There are 6 questions to complete.

You have completed

questions

question

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Correct Answer

You Selected

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Total Questions on Quiz

Question Details

Results

Date

Score

Hint

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minutes

seconds

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Answer Choice(s) Selected

Question Text

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Questions

1. Nortriptyline and protriptyline are classified as what class of TCAs?

A. Amines B. Secondary amines C. Tetracyclics D. None of the above

2. The following are true about depression, except:

A. External causes always play a part in assessment and diagnosis. B. Patients with depression have trouble sleeping and eating. C. Depression can lead to multiple physical problems. D. None of the above.

3. Which TCA is also approved for use in patients with OCD?

A. Imipramine B. Clomipramine C. Sertraline D. Amitriptyline

4. A combination of MAOIs and TCAs will precipitate which drug adverse effect?

Iris Dawn is a nurse writer in her 20s who is on the constant lookout for latest stories about Science. Her interests include Research and Medical-Surgical Nursing. She is currently furthering her studies and is seriously considering being a student as her profession. Life is spoiling her with spaghetti, acoustic playlists, libraries, and the beach.

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